Relationship Of Incidence Of Frailty With Metformin Consumption Habits In Elderly Type-2 Diabetes Mellitus Patients.

Type 2 diabetes (T2DM) was characterised with insulin resistance and deficiency, furthermore with advancing age the was also an increase in insulin resistance. Clinical studies has proven that insulin resistance and T2DM increase the incidence of frailty syndrome in the elderly. Oral antidiabetics metformin was associated with the inhibition of aging process. Eventhough, there was limitless literature and theorical that showed the relationship of metformin therapy to frailty syndrome. This study aimed to explore the possibility of metformin protective effect on frailty syndrome. This research method uses structured descriptive analysis with literature review. Article Data both original article, research article, Review article and case report are collected to be analyzed in accordance with the purpose of the title and writing of this article. Type 2 Diabetes mellitus is characterized by insulin resistance and deficiency which had happened several decades earlier, in addition to the incidence of insulin resistance will also increase. On some clinical studies that have been conducted, insulin resistance and type 2 Diabetes mellitus, it has been shown to increase the number of occurrences of frailty syndrome in old age. Conclusion Metformin was shown to have protective effect against frailty syndrome in elderly diabeti

Self-Perception of Co-Assistant Students Regarding The Covid-19 Pandemic

Background: At the beginning of 2020, the world was shocked by a new type of coronavirus (SARS-CoV-2) whose disease was called Coronavirus disease 2019 (COVID-19). The research aims to determine the self-perception of Co-Assistant students regarding the COVID-19 pandemic. Method: The study was designed cross-sectional, which was conducted via sharing online links. Respondents must Co-Assistant students from a medical faculty in Indonesia and participated in the questionnaire filling between June 2020 and October 2020. This research is a descriptive study with a cross-sectional approach and conducted using primary data (online questionnaire Results: One hundred forty-nine students (149) of Co-Assistant students from several medical faculties all over Indonesia met the inclusive criteria. The samples were dominated by female respondents at 103 students (69.1%), while the male respondent accounted for only 46 students (30.9%). The first year of the Co-Assistant program with 94 respondents (63.1%) followed by the second year of the Co-Assistant program with 55 respondents (36.9%). The highest mean score in the fear zone came from the "first year of Co-Assistant program" group and the highest mean score in the learning and growth zone came from the "second year of Co-Assistant program" group. Conclusion: The highest mean score in the fear zone came from the "first year of Co-Assistant program" group and the highest mean score in the learning and growth zone came from the "second year of Co-Assistant program" group

Comparative analysis of pediatric COVID-19 infection in Southeast Asia, south Asia, Japan, and China

There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures

The Etiologies of Pediatric Acute Respiratory Distress Syndrome (PARDS) in Patients Treated at The PICU of Haji Adam Malik Hospital Medan in 2017 – 2020

Background. Pediatric Acute Respiratory Distress Syndrome (PARDS) is considered to occur due to direct lung injury and indirect lung injury. The research aims to describe the causes of PARDS in patients treated at the Pediatric Intensive Care Unit (PICU) of Haji Adam Malik Hospital Medan in 2017-2020. Method. This type of research is a retrospective descriptive study with a cross-sectional study design uses secondary data in the form of medical records. The population of this study were all PICU patients aged 1 month – 18 years at Haji Adam Malik Hospital Medan in 2017-2020 using consecutive sampling technique. Results. Of the 100 PICU patients, there were 55 male patients with the most age group was <12 months. The most common mode of ventilation used is 80 invasive mechanical ventilation and duration of ventilation used has a mean value of 17.72 days. A mean value of Length of stay (LOS) patient was 25.47 days. Based on the Oxygenation Index (OI), of the 80 patients with invasive mechanical ventilation, most patients were 57 at risk PARDS, meanwhile, based on Oxygen Saturation Index (OSI) categories, of the 20 patients with non-invasive mechanical ventilation, most patients were 15 at risk PARDS. Most caused by indirect lung injury, namely 51 (51%), direct lung injury 47 (47%), and due to complications of using a ventilator as much as 2 (2%). Conclusion. The most common direct lung injury factor is the primary pulmonary infection, aspiration, trauma, and other factors. The most common indirect lung injury factor is sepsis, then central nervous system (CNS) disorders, postoperatively, and other factors

Knowledge and Attitude of Medan Selayang Citizens Toward Kidney Diseases in Children

Background. Renal disease define as groups of heterogenous disease that affect the function and structure of kidney. Children with end-stage renal disease (ESRD) have 30 times mortality rate than children without ESRD. Early signs and symptoms should be recognized and risk factors should be identified early so kidney disease could be prevented and slow the progress towards worse condition. Prevention can be done by parents and society by hindering or eliminating risk factor from children that could cause kidney disease.  Therefore, society’s knowledge and attitude towards children’s kidney disease need to be carried out, especially parents,which are child’s first point contact with medical staff.   Objective. To describe the level of knowledge about symptoms, risk factors, treatment and complications of kidney diseases and precautionary attitude of Medan Selayang citizens towards kidney diseases in children. Methods. The research was a descriptive observational study with cross sectional approach. The sampling method used was non-probability sampling with convenient method. Total sample needed in this research is 100 people who were Medan Selayang citizens that brought children to Puskesmas PB II Selayang.This study used questionnaire as research tool. Results : From 100 respondents, 67% knew that children can get kidney disease and 81% agree that some kidney diseases can be prevented. Conclusion. The knowledge of Medan Selayang’s citizens was still lack especially regarding symptoms, risk factors, and complications. The attitude of the citizens was good.

Development and validation of a clinical predictive model for severe and critical pediatric COVID-19 infection

Introduction: Children infected with COVID-19 are susceptible to severe manifestations. We aimed to develop and validate a predictive model for severe/ critical pediatric COVID-19 infection utilizing routinely available hospital level data to ascertain the likelihood of developing severe manifestations.Methods: The predictive model was based on an analysis of registry data from COVID-19 positive patients admitted to five tertiary pediatric hospitals across Asia [Singapore, Malaysia, Indonesia (two centers) and Pakistan]. Independent predictors of severe/critical COVID-19 infection were determined using multivariable logistic regression. A training cohort (n = 802, 70%) was used to develop the prediction model which was then validated in a test cohort (n = 345, 30%). The discriminative ability and performance of this model was assessed by calculating the Area Under the Curve (AUC) and 95% confidence interval (CI) from final Receiver Operating Characteristics Curve (ROC).Results: A total of 1147 patients were included in this analysis. In the multivariable model, infant age group, presence of comorbidities, fever, vomiting, seizures and higher absolute neutrophil count were associated with an increased risk of developing severe/critical COVID-19 infection. The presence of coryza at presentation, higher hemoglobin and platelet count were associated with a decreased risk of severe/critical COVID-19 infection. The AUC (95%CI) generated for this model from the training and validation cohort were 0.96 (0.94, 0.98) and 0.92 (0.86, 0.97), respectively.Conclusion: This predictive model using clinical history and commonly used laboratory values was valuable in estimating the risk of developing a severe/critical COVID-19 infection in hospitalized children. Further validation is needed to provide more insights into its utility in clinical practice